Voice, access, and ownership: enabling environments for nutrition advocacy in India and Nigeria.

What constitutes an enabling environment for nutrition advocacy in low- and middle-income countries? While a sizeable body of scholarship considers the enabling environment for nutrition policy, we focus specifically on the necessary conditions for advocacy. We argue that three factors-voice, access, and ownership-provide a useful lens into the advocacy enabling environment. These are operationalized, respectively, as the space to articulate and frame policy positions, entry points to interact with policy decision makers, and the existence of committed decision makers rather than those responding to pressures from external actors. These three factors are explored vis-à-vis a comparative analysis of two federal democracies-India and Nigeria-that each have vibrant advocacy communities confronting persistent malnutrition. Drawing on more than 100 structured interviews with nutrition advocates, government actors, donors, and researchers in the two countries, we highlight the ways in which voice, access, and ownership interactively shape advocacy efforts. In doing so, we find that Nigeria has a less ideological approach to certain nutrition issues than in India but also perceived to be more beholden to external actors in defining its nutrition actions. Recent restrictions on freedom of speech and association shrunk the civic space in India but these were less problematic in Nigeria. In both countries, the multi-tiered, multi-party system offers many different points of access into the policy arena, with sometimes negative implications for coordination. Overall, the paper contributes more broadly to the literature on enabling environments by highlighting potential indicators to guide nutrition advocates in other settings.

In Vitro Antimalarial Susceptibility of Plasmodium falciparum and Plasmodium berghei Isolates to Selected Antimalarial Agents, Column Chromatographic Subfractions of Glyphaea brevis Leaves Extract and FTIR and GCMS of SF8.

Malaria still remains a life-threatening parasitic disease with universal targets set for control and elimination. This study aimed to evaluate the in vitro antimalarial susceptibility of Plasmodium falciparum isolates and Plasmodium berghei to selected antimalarial agents and column chromatographic subfractions of Glyphaea brevis leaves extract and FTIR and GCMS of SF8. Trager and Jensen as well as World Health Organisation (WHO) standardised in vitro micro-test system methods were used to determine susceptibility on the patients' blood samples; Column chromatographic procedure was carried out to obtain 11 pooled fractions; FTIR and GCMS were used to determine functional groups and phytochemicals respectively. In vitro anti-plasmodial activity against P. falciparum clinical isolates had IC50 range of 1.03 µg/mL-7.63 µg/mL while their IC50 against P. berghei ranges from 4.32 µg/mL-7.89 µg/mL. Subfraction 8 (SF8) had the least IC50 of 4.32 µg/mL. The FTIR spectrum showed the presence of isoprenoid, alcohol, phenol, alkane, alkenes, ester, carboxylic acids, aromatics and nitro compounds while GCMS identified dodecanoic acid, methyl ester; carotol; hexadecanoic acid, methyl ester; 9-octadecenoic acid (Z)-, methyl ester (oleic acid); methyl stearate; heptadecanoic acid, 16-methyl-, methyl ester; all with their antimalarial reported activities. In conclusion, G. brevis has a great potential for drug development against malaria parasite since it inhibited schizont growth and possesses phytocompounds with antimalarial report.

Prooxidant effects of high dose ascorbic acid administration on biochemical, haematological and histological changes in Cavia porcellus (Guinea pigs): a Guinea pig experimental model.

Introduction: Ascorbic acid (AA) is a water-soluble vitamin that is well known for its antioxidant and immune-boosting properties. Owing to the wide-range application of AA in the treatment of numerous ailments and its sweet taste, it is usually abused i.e. overused. However, the effect of the abuse has rarely received attention. Therefore, this study was designed to assess the effect of oral administration of high-dose ascorbic acid on biochemical and haematological parameters as well as the effects on the kidney, liver and lungs. Methods: adult guinea pigs were divided into four (4) groups where group 1 served as the untreated control group and groups 2-4 were dosed with 29 mg, 662 mg and 1258 mg of ascorbic acid per day, respectively for 28 days. Results: the result revealed that administration of high dose ascorbic acid significantly (P<0.05) increased serum creatinine from 50.0 ± 7.09 (NC) to AA29- 73.8 ± 4.5, AA-662-89.7 ± 3.3 and AA1258- 79.9 ± 5.7mmol/L and urea levels in the treatment group AA-1258 -18.3 ± 0.5 µmol/L compared to the normal group (NC-2.15 ± 0.6 µmol/L). Disturbance in electrolyte balance was observed with a significant (P<0.05) increase in Na+ from NC- 131.3 ± 3.5 mmol/L to 135.7 ± 3.6 mmol/L in the AA-1258 treatment group, Cl- ( NC- 67.1 ± 1.6 mmol/L increased to AA29- 92.1 ± 0.83, AA662- 95.3 ± 1.3 and AA-1258- 95.6 ± 0.4 mmol/L), and Ca2+ (NC- 2.66 ± 0.03 to AA1258- 3.36 ± 0.03 mmol/L) and a significant (P<0.05) decrease in serum K+ in the AA29-5.0 ± 0.2, AA662-5.2 ± 0.3 and AA1258-5.6 ± 0.3 mmol/L treatment groups compared to the normal group 6.6 ± 0.3 mmol/L. There was also a significant (P<0.05) increase in the differential blood count in the animals with a significant (P<0.05) increase in red blood count ( NC-5.11 ± 0.13 ×106/µL to AA1258- 5.75 ± 0.11×106/µL ), haematocrit count (NC 39.90 ± 0.52% to AA-29-42.08 ± 0.24 and AA1258-46.13 ± 0.86%), white blood count (NC 10.15 ± 1.01 ×103/µL to AA1258- 15.18 ± 1.65×103/µL ), total lymphocytes (NC 3.5 ± 0.51×103/µL to AA29-5.28 ±0.43×103/µL), monocytes (NC 0.45 ± 0.07×103/µL to AA1258 0.80 ± 0.07×103/µL), eosinophils (NC 0.23 ± 0.03×103/µL to AA12580.40 ± 0.03×103/µL), basophils (NC0.68 ± 0.10×103/µL to AA12581.20 ± 0.10×103/µL) and neutrophil count (NC 4.73 ± 0.68×103/µL to AA1258 8.36 ± 0.71×103/µL). The histopathological indices indicate cellular necrosis in the AA662 and AA1258 treatment groups of the kidney and liver respectively compared to the normal control which has normal cells. Conclusion: high dose of ascorbic acid can therefore be suggested to cause damage to the cells by causing cellular necrosis as observed in the histopathology results and has effect on the blood cells as observed in the increase compared to the normal control, and the consequences are possibly triggered through inflammatory responses.

Advocacy organizations and nutrition policy in Nigeria: identifying metrics for enhanced efficacy.

Advocacy organizations have played a significant role in the field of nutrition in recent years. However, why are some advocates viewed as more effective than others? This paper derives metrics for assessing advocacy efficacy by first drawing on key insights from the nutrition and public policy scholarship. A set of metrics is proposed to capture the constitutive elements of three concepts that often emerge as critical from that literature: organizational capacity, strong networks and external outreach. Based on a survey of 66 nutrition stakeholders in Nigeria, including at the federal level and within the states of Kaduna and Kano, the metrics are then applied to a set of advocacy organizations within the country. We show that the metrics can provide insights into why some advocacy organizations are perceived as more effective than others by policymakers. Specifically, we find that geographical reach, the share of budget allocated to advocacy, action plans with clear objectives, large networks that include government and non-governmental policy champions, multiple media and dissemination outputs and numerous training events collectively increase nutrition advocates' visibility to, and influence on, policymakers. Although the metrics are subject to further testing in other country settings and need to be interpreted based on a country's underlying policy system, they offer a useful starting point for more systematic, comparative advocacy analysis and learning within the nutrition field and beyond.

Factors Influencing Exclusive Breastfeeding in Early Infancy: A Prospective Study in North Central Nigeria.

PURPOSE: To determine the association between prenatal exclusive breastfeeding intentions and exclusive breastfeeding (EBF) and explore other factors associated with EBF until 3 months postpartum among mothers residing in suburban parts of the Federal Capital Territory, Abuja Nigeria. DESCRIPTION: This longitudinal observational study involved the recruitment of 210 pregnant women who were prospectively followed until 3 months postpartum. Participants were recruited from antenatal clinics attached to four separate public secondary health facilities located in the suburban parts of Abuja. Cox regression hazards model was used to determine the risk of EBF cessation at 3 months postpartum. ASSESSMENT: Over 70.0 % of women had strong intention to exclusively breastfeed. The risk of exclusive breastfeeding cessation was significantly lower in women with strong exclusive breastfeeding intentions (HR 0.87, 95 % CI 0.8-0.95). Other risk factors for cessation of exclusive breastfeeding were pre-lacteal feed administration (HR 2.93 95 % CI 1.49-5.77) and mode of delivery (HR 0.17 95 % CI 0.04-0.67). Higher maternal age (≥35 years), religion (Muslim) and having an unplanned pregnancy lowered the likelihood of having a strong intention to exclusively breastfeed an infant. CONCLUSIONS: Prenatal exclusive breastfeeding intention was a strong predictor of exclusive breastfeeding. Intentions to EBF were further explained by maternal characteristics. Effective promotion of exclusive breastfeeding during prenatal period should also target factors influencing breastfeeding intentions. Additional research is warranted into the influence of maternal attitudes and self-efficacy about breastfeeding on breastfeeding intentions and practice.

Factors influencing breastfeeding exclusivity during the first 6 months of life in developing countries: a quantitative and qualitative systematic review.

Breastfeeding is the most advantageous feeding option for infants, and epidemiological studies provide evidence for its promotion. The objective of this review was to comprehensively delineate the barriers and facilitators of exclusive breastfeeding of infants aged 0-6 months old by mothers in developing countries. A search of CINAHL, MEDLINE and PsycINFO was carried out to retrieve studies from January 2001 to January 2014. Using our inclusion criteria, we selected studies that described barriers and facilitators of exclusive breastfeeding. Qualitative and quantitative studies were considered. Twenty-five studies involving 11 025 participants from 19 countries were included. Barriers and facilitators of exclusive/full breastfeeding were identified, analysed tabulated and summarised in this review. Maternal employment was the most frequently cited barrier to exclusive breastfeeding. Maternal perceptions of insufficient breast milk supply was pervasive among studies while medical barriers related to illness of mothers and/or infants as well as breast problems, rather than health care providers. Socio-cultural factors such as maternal and significant other's beliefs about infant nutrition also often constitute strong barriers to exclusive breastfeeding. Despite these barriers, mothers in developing countries often possess certain personal characteristics and develop strategic plans to enhance their success at breastfeeding. Health care providers should be informed about the determinants of exclusive breastfeeding and provide practical anticipatory guidance targeted at overcoming these barriers. In so doing, health care providers in developing countries can contribute to improving maternal and child health outcomes.

Data collection and assessment of commonly consumed foods and recipes in six geo-political zones in Nigeria: important for the development of a National Food Composition Database and Dietary Assessment.

A cross-sectional study was undertaken to collect and assess commonly consumed foods/recipes from the six geopolitical zones in Nigeria for the production of food composition database (FCDB) for dietary assessment. Communities used were selected using a multi-stage sampling plan. Focus group discussions, interviews, recipe documentation, food preparations and literature reviews were employed. Qualitative methods were used to analyse and present data. SWOT (strengths, weaknesses, opportunities, and threats) analysis was used to evaluate the project. A total of 322 recipes were collected out of which 110 were soups. Food consumption patterns across the geographical zones were found to be changing. Variations in recipes and methods of preparation of similar foods were observed. Factors to be considered in the development of a country-specific FCDB were identified. There were challenges with the use of values reported in literature for Nigerian foods. The study justifies the need for a country-specific FCDB that will include traditional recipes.

Knowledge, attitude and practice of home management of childhood diarrhoea among caregivers of under-5 children with diarrhoeal disease in Northwestern Nigeria.

OBJECTIVES: Diarrhoeal diseases (DDs) constitute public health problem. Reduction in related mortality and morbidity hinges on active participation of home caregivers. It is pertinent to determine the degree of their empowerment. DESIGN: Cross-sectional study. SETTING: Randomly selected community primary health centres in northwestern Nigerian. SUBJECTS: Home caregivers presenting with children aged 1-59 months having DD. OUTCOME MEASURES: Knowledge, attitude and practice regards home management of DD. RESULTS: Less than 1% of caregivers was knowledgeable about home management of DD. Antibiotics and anti-diarrhoeal agents use was common at 36%. ORS use was abysmally low at 8.6%. Only 32% of caregivers were aware of the use of zinc in the management of DD. Adherence to 10-day zinc supplementation was encouraging at 75.5%. CONCLUSION: There is an urgent need to scale up educational and promotional activities with regards to the home management of DD if the millennium development goals are to be met.